World Indigenous Cancer Conference (12-14 April 2016)
The International Agency for Research on Cancer (IARC) and the Menzies School of Health Research are launching the inaugural World Indigenous Cancer Conference. The 3-day event, which starts today in Brisbane, Australia, brings together researchers and public health practitioners as well as advocacy groups and indigenous community groups. Globally, cancer in indigenous populations has largely been overlooked. The high incidence rates in indigenous populations of preventable cancers such as lung and cervical cancers indicate that cancer surveillance, targeted prevention, early detection, and vaccination programmes could reduce the cancer burden in indigenous communities around the world. Dr Freddie Bray, Head of the Section of Cancer Surveillance at IARC, gives an overview of the cancer burden in these populations.
Concretely, what is IARC’s contribution towards better defining and understanding how indigenous populations are affected by cancer?
We know the risk of cancer is increasing in countries characterized as low- and middle-income as they transition towards higher levels of social and economic development. Given this trend, coupled with population ageing and growing population sizes, there will be global increases in cancer incidence over the coming decades.
At the same time, we also know that there are major disparities within countries, and we saw a tremendous opportunity at the International Agency for Research on Cancer (IARC) to embark on a collaborative partnership to bring together researchers across countries and organizations to better understand the magnitude and profile of cancer among indigenous peoples. At the time we first conceived of this partnership, the poorer general health and lower average life expectancy of indigenous peoples had been documented, but there had been no systematic comparison of cancer incidence rates in indigenous populations relative to their non-indigenous counterparts, across high-income countries.
Dr Sue Moore, from Queensland, Australia, was the first recipient of the IARC-Australia Fellowship. She came to IARC and we worked with many experts in collecting the available data from four high-income countries with major indigenous populations: Australia, Canada, New Zealand, and the United States. The study’s results are based on incidence rates from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the Canadian province of Alberta, and the Contract Health Service Delivery Areas of the USA.
Age-standardized incidence rates by registry, year, sex, cancer site, and ethnicity for 2002-2006 were compared.
The paper was published in The Lancet Oncology in November 2015, led by Sue Moore and an excellent team of experts.
From your work on the topic, can you give an overview of the situation?
The overall cancer burden tended to be lower in indigenous peoples than in the rest of the population (the exceptions were in New Zealand and among Alaska Native women in the USA).
In both indigenous and non-indigenous populations, the most common cancers among men were lung, prostate, and colorectal cancers and among women were breast, lung, and colorectal cancers. However, clear disparities and differences were found in the rates of specific cancers among populations, with indigenous communities disproportionately affected by cancers related to smoking (such as lung cancer and head and neck cancers) and related to infections (including stomach, liver, and cervical cancers).
For lung cancer, the incidence rate among Māori women in New Zealand was 4 times that among non-Māori women, and the rate among Māori men was 2.5 times that among non-Māori men. The rates of lung cancer among indigenous peoples in all three territories of Australia were 40-75% higher than those among non-indigenous peoples, for both men and women. In Alberta, Canada, there were higher rates of lung cancer in both men and women, but lung cancer incidence rates among Alaska Natives were about 50% higher than those among White individuals, for both men and women.
Head and neck cancers, which are known to be associated with smoking, were more common among indigenous peoples, for both men and women.
The cervical cancer incidence rate among indigenous women (in Queensland and the Northern Territory, Australia) was more than 2.5 times the rate in non-indigenous women
Why is it important to focus on this population and this disease, knowing there are many other health priorities?
Indigenous peoples constitute about 6% of the world’s population, and their poorer health and social disadvantage has become a global health issue.
From a global perspective, cancer in indigenous populations has largely been overlooked, despite evidence that indigenous peoples in some areas have significantly greater mortality and lower cancer survival rates.
Greater understanding of the burden of cancer among indigenous populations is of major importance to public health, given that poorer outcomes contribute to the lower life expectancies experienced by many indigenous peoples.
The poorer general health and lower average life expectancy of indigenous peoples has already been documented, and cancer is a major contributor. Our study was the first to systematically compare cancer incidence rates in indigenous populations relative to their non-indigenous counterparts across these high-income countries.
“Lung cancer was the most commonly occurring cancer among indigenous populations in our study,” says Dr Suzanne Moore, the lead author of the study. “Smoking appears to be highly prevalent in indigenous communities in all four countries compared with their non-indigenous counterparts. Smoking is a major risk factor for a number of cancers, such as those of the lung, oral cavity, head and neck, oesophagus, stomach, and cervix.”
The global study highlights the potential for prevention. The high incidence rates in indigenous populations of preventable cancers such as lung and cervical cancers indicate an urgent need for communities and governments to work together to improve cancer surveillance, targeted prevention, early detection, and vaccination programmes.
Ultimately, the goal of the study is to provide critical evidence in developing and implementing targeted cancer control policies to reduce the burden in these communities worldwide.
What’s next? What do you hope to achieve in the near future?
We have the inaugural World Indigenous Cancer Conference 2016 (WICC 2016) in Brisbane, Australia,. This is a 3-day event hosted by the Menzies School of Health Research and held in partnership with IARC.
The theme of WICC 2016 is “Connecting, Communicating and Collaborating across the Globe”, and there will be participation from a wide variety of groups involved in indigenous health and well-being, including researchers, health professionals, clinicians, nurses, advocacy groups, and indigenous community groups and leaders around the world.
The conference will provide opportunities to foster new collaboration, enhance capacity, and share knowledge and information about cancer and indigenous peoples internationally.
There is much to do, but we can help reduce indigenous cancer disparities by bringing together indigenous communities and experts working in a variety of disciplines to develop international collaborations and high-quality cancer research. At the same time, we are also working with indigenous groups and governments to use our study as an evidence base to bring about the necessary actions that will drive down the disparities in cancer in indigenous communities and bring about greater equity in health and well-being.